One facet down, one to go

I continue to wonder what would happen if the facets were inflammed. The inflammation would then cause surrounding spinal nerves etc to become inflammed, causing them to become more sensitive and generate pain.

I am not convinced a facet block with anesthetic would actually eliminate this pain, since the inflammation would cause inflammed "pain generators" throughout the area.

I hypothesize spreading inflammation would make pinpointing the primary source of pain very difficult.

Paul

[annapurna]

Great discussion everyone and thanks for all the comments. You've got a good point Paul. If facets (or any other structure) got inflammed enough to cause surrounding structures to also get irritated (inflammatory enzymes or such?), then, even if the original pain generator were removed, the secondary sources would continue - thereby eliminating the specificity and sensititivity both of the diagnostic injection. If this is the case, then perhaps some systemic anti-inflammatory drug to calm down the secondaries might make the primary generator easier to distinguish. Dr. Yeung discussed a mechanism in which synovial fluid from a leaking facet capsule "dripped" onto the spinal nerve root ganglion below it causing fairly intense pain. I doubt that either of these mechanisms is active in my particular case because the MRI imaging showed no irritation of the facet capsules, and, for inflammation to "jump" to other structures, it would probably need to be severe enough in the primary structure to be radiographically visible on MRI (there's my uneducated guess, anyway).

As far as soft tissues pain generators go, I'm going to look into lax and micro-torn ligaments. All of my joints are somewhat hypermoble, and my ligaments tend to be a bit lax everywhere. It is very easy to see how the ones in my spine may have sustained some damage and be painful from microtrauma, rapid stretching post-ADR, or whatever. It would also not surprise me if they are lax enough to allow some micro-instability that could be causing pain elsewhere. Oddly enough, the concept of painful ligaments was Dr. Zeeger's initial idea of my main pain generator post-ADR, so, that gives me some confidence.

As for what to do, I'm going to investigate prolotherapy and, maybe Rolfing (that myofacial re-alignment treatment). The prolotherapy is a fairly straightforward way to strengthen ligaments, as much as the idea of deliberately building more scar tissue seems a bit odd. The goal with the Rolfing would be mainly a general soft-tissue re-alignment to make sure that muscles and ligaments being strengthened via target excercises and prolotherapy are all pulling in the right direction.

I'll be spending the next few weeks working on my cranky right knee, so, back and spine therapy will have to wait until February probably, unless I can do something at the Klinik after I get my knee worked on (again, sigh).

If anyone has any ideas, or thinks I barking up a tree, let me know. Oftentimes, it's the accumulation of little observations and ideas that forms great solutions.

Best Wishes to All!!!
Laura